The ALPHA network pooled data gathered between June, 1989 and April, 2012 in six community-based studies in eastern and southern Africa with HIV serological surveillance and verbal-autopsy reporting. Deaths occurring during pregnancy and up to 42 days post partum were defined as pregnancy related. Pregnant or post-partum person-years were calculated for HIV-infected and HIV-uninfected women, and HIV-infected to HIV-uninfected mortality rate ratios and HIV-attributable rates were compared between pregnant or post-partum women and women who were not pregnant or post partum.
138?074 women aged 15-49 years contributed 636?213 person-years of observation. 49?568 women had 86?963 pregnancies. 6760 of these women died, 235 of them during pregnancy or the post-partum period. Mean prevalence of HIV infection across all person-years in the pooled data was 17¡¤2 % (95 % CI 17¡¤0-17¡¤3), but 60 of 118 (50¡¤8 % ) of the women of known HIV status who died during pregnancy or post partum were HIV infected. The mortality rate ratio of HIV-infected to HIV-uninfected women was 20¡¤5 (18¡¤9-22¡¤4) in women who were not pregnant or post partum and 8¡¤2 (5¡¤7-11¡¤8) in pregnant or post-partum women. Excess mortality attributable to HIV was 51¡¤8 (47¡¤8-53¡¤8) per 1000 person-years in women who were not pregnant or post partum and 11¡¤8 (8¡¤4-15¡¤3) per 1000 person-years in pregnant or post-partum women.
HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24 % of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women.
Wellcome Trust, Health Metrics Network (WHO).